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If the vet was on board with trying a powerpac, I'd give it a go. I have in the past had it make a huge difference in a horse that had some mild colic and/or tie up issues, and we had tried much the same as you did (vet exams during and after episodes, blood work, ulcer meds). The powerpac made a huge difference in my horse, and long as there are no concerns about it (which is why I'd want vet approval), I'd do it.

And I don't recall reasons why, but vet* told me specifically to use the powerpac and not Quest Plus... *vet was an internal med type specialist that I was referred to back east, so he did not see horse, but he was an enormous help then and later when dealing with my IR horse and interpreting blood work, etc. I believe that he felt the powerpac was more effective than the Q Plus, but I don't recall exactly as that was a few years back.

ETA: noting that this was all based on my horse's particular situation and symptoms, worming history, etc., and may not apply to the OP's horse or any other. Whether to use any product, or a specific product, should be discussed with the actual treating vet. I'm just some random horse owner on the Internet and my experience and words should be valued as such.

How, pray tell, does one palpate for gastric ulcers?
And not all manifest with a positive fecal blood test result.

By the ulcer accupressure points. The one vet that I use says he has only been wrong once of 50 horses that he scoped. I see pretty much all vets do this and it is accurate if you know what your doing.

Why do you say they don't all show up on fecal blood tests. From what I know and from what I just read they do. That's why a lot of vets are using that method now as a tool.

Please keep in mind that if there are encysted strongyles a PP may make this horse worse. A PP kills the ESs in place, where they die and cause ulcerations right there, very much like when they emerge. That is why Quest is better than a PP.

The ONLY reason a PP is better than Quest, from a functional perspective, is that moxidectin does not kill the EL3 stage. But that's a fairly insignificant part of an encysted colony that it is not worth taking the chances of causing colicky issues with the ulcerations.

By the ulcer accupressure points. The one vet that I use says he has only been wrong once of 50 horses that he scoped. I see pretty much all vets do this and it is accurate if you know what your doing.

Why do you say they don't all show up on fecal blood tests. From what I know and from what I just read they do. That's why a lot of vets are using that method now as a tool.

Where have you read that *all* ulcer problems show up on fecal blood tests?

Please keep in mind that if there are encysted strongyles a PP may make this horse worse. A PP kills the ESs in place, where they die and cause ulcerations right there, very much like when they emerge. That is why Quest is better than a PP.

The ONLY reason a PP is better than Quest, from a functional perspective, is that moxidectin does not kill the EL3 stage. But that's a fairly insignificant part of an encysted colony that it is not worth taking the chances of causing colicky issues with the ulcerations.

I can only say that what was suggested was specific to my vet and horse situation only, as I reported. I would not suggest doing anything without vet approval, which I said. I think I'll go back and edit with that disclaimer.

This is how we discovered my mare had issues with ovulating. It started early jan one year with intermittent colics and extra grumpiness under saddle. In between her heats she was fine and the first year it wasn't every cycle and they were milder. The second year she was colicking every three weeks on cue with her cycle. Turned out it was when she ovulated it caused her massive pain and cramping. So wasn't a true colic but looked like one as same symptoms. Banamine and buscospan (sp? A muscle relaxant) helped her until I could get her spayed.

If she colics again I would recommend an ultrasound. It will tell you if your mare just ovulated or not. Or could try her on regumate and see if that helps.

Sarabeth / CrowneDragon Enteroliths might be a possibility but I don't believe that they are very common in Ontario? Our soils tend to be very deficient in minerals with lots of grass pasture. The amount of alfalfa she is fed is such a small percentage (maybe 2 pounds per day) compared to the amount of regular grass and grass hay we feed.

And if its a lipoma I think we're SOL. She is only 5 and not grey so hopefully that reduces some of the risk of that being the case...

Enterolith does sound unlikely.

A lipoma is a fatty tumour that has nothing to do with being grey. They are most common in older and overweight horses, so your horse would be a very unlikely candidate.

If you have EPSM-PSSM in mind, do think about the muscle biopsy test.
My guy, a Belgian, came up negative with the hair follicle ( there's the whole blood test that done as well), but that's looking for the type 1 mutation (more common in drafts), so I was glad I had the muscle Bx done, because it showed Type 2.

Hind gut stuff would be good to look into as well. I 've been dealing with that as well recently.

JAN. 12, 2013 — Horsemen’s Laboratory receives several questions a week about encysted strongyles. The most often asked question is, “How do I know if my horse has encysted strongyles?” There are three ways to determine if your horse has encysted strongyles.

Have surgery performed and have the lining of the large intestine examined for them.

If the horse dies, have a necropsy performed and have the lining of large intestine examined for them.

The most rational way to find out is to do a series of fecal egg counts over a year or so. Though not as precise as the first two methods, fecal egg counts will be much less expensive, and invasive.

There are some people who think that fecal egg counts cannot determine the presence of encysted strongyle larvae. It is true that a single fecal egg count cannot determine their presence directly. However, fecal egg counts repeated over time will indicate the likelihood that encysted strongyle larvae are present. Knowing something about the life cycle of small strongyles is critical to understanding why this is so.
We should first understand that every adult strongyle was once an encysted strongyle larva in the lining of the large intestine. Therefore, eggs in the horses stool are indicative of adult strongyles in the intestine that once were encysted. At this point we should review the life cycle of small strongyles.Strongyle Life Cycle

Eggs are laid in large intestine by adult strongyles.

Eggs are passed in the horse’s stool.

Eggs hatch and develop into 3rd stage infective larvae. As the eggs hatch, they go through 3 larval stages in approximately 1 week under ideal conditions of 65-85 degrees F with moisture. The 3rd stage develops a coating that protects them when eaten by a horse. Infective larvae climb the grass stalk and wait for a passing horse to eat them.

The 3rd stage infective larvae are eaten by the horse while grazing and pass into large intestine.

Once eaten by the horse, the larvae burrow into the mucosal lining of the large intestine and become encysted. The larvae can remain in cysts for anywhere from two weeks to more than two years. It is not well understood what causes the larvae to leave the cyst (excyst) and become adult strongyle worms.

Larvae excyst, become adults, and begin laying eggs, which are then seen in the stool sample.

As the life cycle indicates, every encysted larva began as an egg passed in the stool of a horse and will at some point develop into an egg-laying adult.

The most rational way to find out is to do a series of fecal egg counts over a year or so. Though not as precise as the first two methods, fecal egg counts will be much less expensive, and invasive.

There are some people who think that fecal egg counts cannot determine the presence of encysted strongyle larvae. It is true that a single fecal egg count cannot determine their presence directly. However, fecal egg counts repeated over time will indicate the likelihood that encysted strongyle larvae are present. Knowing something about the life cycle of small strongyles is critical to understanding why this is so.
We should first understand that every adult strongyle was once an encysted strongyle larva in the lining of the large intestine. Therefore, eggs in the horses stool are indicative of adult strongyles in the intestine that once were encysted. At this point we should review the life cycle of small strongyles.

that's all true, but at that point they are no longer encysted, so knowing they WERE encysted doesn't help you in the here and now, and isn't a terribly good reason to do a PP.

I agree that regular FECs are key to any horse's program to make sure the chemicals you're using are (still) effective, and to determine his inherent immunity in that environment. If the horse has a high FEC, then yes, at one point he had a large encysted colony, and may currently have one which is waiting to emerge but is holding off because of the current adult population, so Quest would be a good choice at that point - kill the adults as well as the majority of the encysted larva.

Because of the resistance of worms to fenbendazole, it's becoming more of a problem with a resistance to the Power Pack as well, which is yet another reason to avoid the PP unless and until you can do a FEC and a FECRT to prove that fenbendazole works on that farm.

I have noticed no correlation with heat cycles. Winter colics were after when I expect her to cycle (and she was fine through the summer months). I do not think she has cycled yet as spring is just arriving here. Vet did palpate ovaries while doing the rectal and commented that they do not seem painful.

The timing seems to always be around 4; in from outside, lunch and then not feeling well. Just got another message that she is lying down and am on my way to look at her. She was ridden moderately yesterday at about 8 pm. So another episode almost 20 hours after exercise. Is it possible for tying up to occur with such late onset?

I just looked up her previous labs and her CK about 12 hours post exercise was 254 U/L. Not in the high range but not low either...

While horses produce acid continuously, they do spike when they expect to be fed. If she's got ulcers, and is usually fed at, say, 4:30, she could be spiking acid production and making a sore ulcery stomach painful.

Scoping is really easy enough and ulcers are so easy to truly rule out. It's a good place to start. While no improvement on omeprazole and ranitadine is *suggestive* of no ulcers, it's really not definitive unless you treated for a full 30 days. If the ulcers are bad enough, a short course may provide no outward effect.

By the ulcer accupressure points. The one vet that I use says he has only been wrong once of 50 horses that he scoped. I see pretty much all vets do this and it is accurate if you know what your doing.

Why do you say they don't all show up on fecal blood tests. From what I know and from what I just read they do. That's why a lot of vets are using that method now as a tool.

Given the high incidence of EGUS, IMHO, the so-called diagnostic points for ulcers don't impress me all that much. (and I say that as someone who does use a fair amount of acupuncture.)

In other words, if over 50% of horses have ulcers, acupuncture "diagnosis" of ulcers is going to be accurate more often than not.

I'm sure your vet checked, but you have not said if you did a test for sand. We had a horse with similar symptoms, (colic-ish after work) and it was because of sand that moved around in the gut during work. How long did you treat for ulcers? If ulcers are bad it can take a month to see results. And I hate to say it but I find Gastro Gard works much better than plain omeprazole for the ones with bad ulcers.